Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines

Fallon, Marie; Giusti, Raffaele; Aielli, Federica; Hoskin, Peter; Rolke, Roman; Sharma, Manohar; Ripamonti, Carla

doi:10.1093/annonc/mdy152

Cited by 527 publications

(704 citation statements)

References 169 publications

(185 reference statements)

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“…Some additional guidelines were developed based on this treatment to assist in the management of cancer pain. [5][6][7] Despite major advances in the treatment of pain, numerous studies show that undertreatment of pain remains a problem throughout the world. 8 Surveys suggest that many patients with cancer continue to experience pain even when analgesics are prescribed.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of pharmacist interventions as part of a multidisciplinary cancer pain management team in a Chinese academic medical center

Liu¹,

Chen²,

Luo³

et al. 2020

Journal of the American Pharmacists Association

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Section: Introductionmentioning

confidence: 99%

Evaluation of pharmacist interventions as part of a multidisciplinary cancer pain management team in a Chinese academic medical center

Liu¹,

Chen²,

Luo³

et al. 2020

Journal of the American Pharmacists Association

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“…Cancer pain medicine can fit into this dynamic perfectly, as one of the major dimensions of supportive care, if essential conditions are respected. It is an exhaustive and demanding type of medicine which in recent years has also undergone its own series of determining changes, both in terms of pathophysiological knowledge, diagnosis, or treatment options (be they drug-based, interventional, or non-drug-based [4,5]). Managing cancer pain implies all these prerequisites and cannot be based solely on a simplistic equation that goes from pain as a symptom to a single, drug-based response.…”

mentioning

confidence: 99%

“…However, some improvements still need to be done as dedicated access to cancer pain specialists support remains heterogeneous despite international guidelines [4]. In particular, tailored cancer pain training programs must be implemented within the pain community, and this true interdisciplinary approach has to be accepted and integrated in daily practices by oncology teams [4,5].…”

mentioning

confidence: 99%

“…As witnesses to these changes, we have created a group of clinical doctors with different, complementary initial specializations and means of operating. Through a series of articles, this group has tried to put forward its vision of cancer pain management by cross-referencing views, clinical experience, and the international literature including the latest recommendations [4,5].…”

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confidence: 99%

“…Understanding cancer pain through this approach is a major key to provide an optimal management for our patients with cancer pain. Rather than a step-wise approach, this exhaustive pain medicine leads to multimodal and personalized responses, by associating interventional and integrated complementary approaches to current therapeutics strategies [4][5][6][7][8][9], and beyond, opening the way to supportive medicine in a simple, integrative, dynamic patients' management model. Integrating supportive medicine to cancer and serious chronic diseases pathway can be a key operational response, in parallel to the constant hyperspecialization of medicine.…”

mentioning

confidence: 99%

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Modeling cancer pain: “the times they are a-changin’”

Lemaire

2019

Support Care Cancer

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EditorialThe last few years have been marked by the emergence of supportive care, and it has been clearly substantiated by evidence. Many authors have highlighted different models for early integration of supportive care [1], from as early as the cancer diagnosis. These integrative models in cancer have demonstrated their positive impact in terms of patient quality of life, symptoms management, health costs, and optimization of care pathways, regardless of the management method (outpatient, in hospital, home care) [2]. In addition to these validated results, the relevance of the models also lies in the fact that they put the spotlight on other means of looking at cancer medicine: interdisciplinarity, development of paramedical skills, decompartmentalization of hospital and community medicine, personalized approach to the patient's care pathway, anticipation and prevention of disruptions to care [3], and a continuum that abolishes the palliative/curative dichotomy in favor of adaptation to patients, their issues, and their environment. These changes-which, for now, remain the fruit of initiatives or research work-are nevertheless not yet the norm when it comes to structuring care in oncology at a larger scale. They are taking place in parallel to an impressive change in cancer management-with most cancers now considered a chronic condition-and respond in a satisfactory manner to the hyperspecialization of cancer medicine.Cancer pain medicine can fit into this dynamic perfectly, as one of the major dimensions of supportive care, if essential conditions are respected. It is an exhaustive and demanding type of medicine which

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Specialty Palliative Care and Symptom Severity and Control in Adolescents and Young Adults With Cancer

Gupta,

Li,

Kassam

et al. 2023

JAMA Netw Open

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ImportanceAdolescents and young adults (AYAs) with cancer experience substantial symptom burden. Specialty palliative care (SPC) is recommended but often not involved or involved late.ObjectivesTo determine whether patient-reported symptom severity was associated with subsequent SPC involvement and whether SPC was associated with symptom improvement in AYAs with cancer.Design, Setting, and ParticipantsThis cohort study comprised AYAs (aged 15-29 years) with primary cancer diagnosed between January 1, 2010, and June 30, 2018, in Ontario, Canada. Data, including self-reported Edmonton Symptom Assessment System (ESAS) scores, were obtained from health care databases. Specialty palliative care was identified through billing codes and validated algorithms. Final data analysis was performed on April 4, 2023.Main Outcomes and MeasuresAssociations of ESAS scores with subsequent SPC involvement were determined. A difference-in-differences approach was used for patients who died within 5 years of their cancer diagnosis. Case patients (SPC predeath, index date equals first SPC service) were matched 1:1 to control patients (no SPC at equivalent time before death). The study examined whether the difference between 90-day postindex and preindex mean ESAS scores was itself different between case and control patients.ResultsThis study included 5435 AYAs with cancer, with a median follow-up of 5.1 (IQR, 2.5-7.9) years for analyses of general palliative care. Their median age at cancer diagnosis was 25 (IQR, 22-27) years, and more than half were male (2809 [51.7%]). For all symptoms, moderate and severe ESAS scores were associated with an increased likelihood of SPC involvement compared with mild scores. The greatest magnitude of association was seen for pain scores (hazard ratio for severe vs mild, 7.7 [95% CI, 5.8-10.2]; P &lt; .001). A total of 721 AYAs (13.3%) died within 5 years of diagnosis, and 612 of these patients (84.9%) had received SPC before death. Among 202 case-control pairs, SPC involvement was associated with improved pain trajectories (mean scores improved from 3.41 to 3.07 in case patients and worsened from 1.86 to 2.16 in control patients; P = .003). Other symptom trajectories were not affected.Conclusions and RelevanceIn this cohort study of AYAs with cancer, those reporting moderate or severe symptoms through a screening program were more likely to subsequently receive SPC. These findings suggest that SPC was associated with a subsequent decrease in pain severity but did not affect other symptoms. New interventions targeting other symptoms during treatment and particularly at the end of life are needed.

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Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines

Cited by 527 publications

References 169 publications

Evaluation of pharmacist interventions as part of a multidisciplinary cancer pain management team in a Chinese academic medical center

Evaluation of pharmacist interventions as part of a multidisciplinary cancer pain management team in a Chinese academic medical center

Modeling cancer pain: “the times they are a-changin’”

Specialty Palliative Care and Symptom Severity and Control in Adolescents and Young Adults With Cancer

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